ABSTRACT
For many years, the ongoing armed conflict in Afghanistan has limited women’s access to public health facilities, including obstetric care. Consequently, maternal mortality remains high in Afghanistan. The research presented in this chapter aimed to identify and understand the reasons why women with a high risk of obstetric emergency do not reach the facilities of an MSF programme with a focus on maternal mortality. It examines what appears to be contradictory results for the MSF team. On one hand, MSF has successfully socialised the concept of safe birth, so women know to seek medical assistance at delivery. On the other hand, in many cases of direct obstetric complications (DOCs), certain social aspects (for example, bleeding in public) prevent women seeking assistance when it is most urgent. However, this chapter shows that health-seeking behaviour and access to health care are only partly to do with socio-cultural determinants and dynamics. It also details security concerns, as well as practical, financial and economic factors which prevent patients and carers from arriving to clinics and hospitals in time. It will be shown that for Afghan women, ‘safe birthing’ goes beyond the biomedical notion, and the meaning of the ‘safe space’ has a highly symbolic connotation within a context of warfare and insecurity.
